Methods and systems for endovascularly clipping and repairing lumen and tissue defects

ABSTRACT

An implantable closure structure is delivered using minimally invasive techniques, and inhibits the migration of liquid and particulate matter from inside a physiological cavity or opening, such as an aneurysm or a septal defect, as well as inhibiting the flow of liquid and particulate matter, such as from an associated blood vessel or chamber, into the physiological cavity or opening. The device has a closure structure that covers the neck or opening of a cavity and has one or more anchoring structures for supporting and retaining the closure structure in place across the cavity or opening.

REFERENCE TO RELATED APPLICATIONS

This application claims priority to and is a continuation-in-partapplication of U.S. patent application Ser. No. 11/324,827, filed Jan.3, 2006, and PCT International application no. PCT/US006/40907, filedOct. 18, 2006, which claim priority to U.S. Patent Application No.60/728,052, filed Oct. 19, 2005. This application also claims priorityto U.S. Patent Application No. 60/823,730, filed Aug. 28, 2006; U.S.Patent Application No. 60/803,200, filed May 25, 2006; U.S. PatentApplication No. 60/747,400, filed May 16, 2006. The disclosures of allof these applications are incorporated herein by reference in theirentireties.

TECHNICAL FIELD OF THE INVENTION

The present invention relates generally to systems and methods forrepairing defects in physiological lumens, such as defects in bloodvessels or gas passageways of a mammal, using minimally invasivetechniques. More specifically, the invention relates to systems andmethods for occluding undesired openings, clipping and repairing defectsin the anatomy of a human or animal, such as aneurysms, other bloodvessel irregularities, septal defects and other tissue defects, andother passageway irregularities, using minimally invasive techniques.

BACKGROUND OF THE INVENTION

Surgical techniques for closing openings and repairing defects inanatomical lumens and tissues, such as blood vessels, septal defects andother types of physiological irregularities and defects, are highlyinvasive. Surgical methods for clipping aneurysms, for example, requireopening the skull, cutting or removing overlying brain tissue, clippingand repairing the aneurysm from outside the blood vessel, and thenreassembling tissue and closing the skull. Surgical techniques forrepairing septal defects are also highly invasive. The risks associatedwith anesthesia, bleeding and infection during and following these typesof procedure are high, and tissue that is affected during the proceduremay or may not survive and continue functioning.

Minimally invasive surgical techniques may alternatively be used toplace occlusive devices within or across an opening or cavity in thebody, such as in the vasculature, spinal column, fallopian tubes, bileducts, bronchial and other air passageways, and the like. In general, animplantable device is guided to a desired site through a deliverycatheter and may be pushed through an opening at the distal end of thedelivery catheter by a pusher mechanism, such as a pusher or deliverywire, thereby deploying the device at the desired site of intervention.Once the occlusive device has been placed at the desired location, it isdetached from the pusher mechanism without disturbing placement of theocclusive device or damaging surrounding structures.

Aneurysms are bulges in an artery wall, generally caused by a weakeningin the artery wall, that form an opening or cavity and are often thesite of internal bleeding and stroke. In general, the minimally invasivetherapeutic objective is to prevent material that collects or forms inthe cavity from entering the bloodstream, and to prevent blood fromentering and collecting in the aneurysm. This is often accomplished byintroducing various materials and devices into the aneurysm.

Various types of embolic agents and devices are used to reduce risks toa patient associated with the presence of an aneurysm. One class ofembolic agents includes injectable fluids or suspensions, such asmicrofibrillar collagen, various polymeric beads and polyvinylalcoholfoam. These polymeric agents may be cross-linked (sometimes in vivo) toextend the persistence of the agent at the vascular site. These agentsare often introduced into the vasculature through a catheter. Afterintroduction and at the site, the introduced materials form a solidspace-filling mass. Although some of these agents provide for excellentshort term occlusion, many are thought to allow vessel recanalizationdue to absorption into the blood. Other materials, such as hog hair andsuspensions of metal particles, have also been proposed and used topromote occlusion of aneurysms. Polymer resins, such as cyanoacrylates,are also employed as injectable vaso-occlusive materials. These resinsare typically mixed with a radiopaque contrast material or are maderadiopaque by the addition of a tantalum powder. Accurate and timelyplacement of these mixtures is crucial and very difficult. Thesematerials are difficult or impossible to retrieve once they have beenplaced in the vasculature.

Implantable vaso-occlusive metallic structures are also well known andcommonly used. Many vaso-occlusive devices are provided in theconfiguration of helical coils and are constructed from a shape memorymaterial that forms a desired coil configuration upon exiting the distalend of a delivery catheter. The purpose of the coil is to fill the spaceformed by a defect or injury and facilitate formation of an embolus withthe associated allied tissue. Multiple coils of the same or differentstructures may be implanted serially in a single aneurysm or othervessel defect during a procedure. Implantable framework structures arealso used in an attempt to stabilize the wall of the aneurysm or defectprior to insertion of filling material such as coils.

Techniques for delivering a vaso-occlusive device to a target sitegenerally involve a delivery catheter and a detachment mechanism thatdetaches the coil from a delivery mechanism after placement at thetarget site. A microcatheter is initially steered through the deliverycatheter into or adjacent to the entrance of an aneurysm, typicallyaided by the use of a steerable guidewire. The guidewire is thenwithdrawn from the microcatheter lumen and replaced by the implantablevaso-occlusive coil. The vaso-occlusive coil is advanced through and outof the microcatheter and thus deposited within the aneurysm or othervessel abnormality. Implantation of the vaso-occlusive device within theinternal volume of a cavity and maintenance of the device within theinternal volume of the aneurysm is crucial. Migration or projection of avaso-occlusive device from the cavity may interfere with blood flow ornearby physiological structures and poses a serious health risk.

One type of aneurysm, commonly known as a “wide neck aneurysm” is knownto present particular difficulty in the placement and retention ofvaso-occlusive coils. Wide neck aneurysms are generally referred to asaneurysms of vessel walls having a neck or an entrance zone from theadjacent vessel that is large compared to the diameter of the aneurysmor that is clinically observed to be too wide to effectively retainvaso-occlusive coils deployed using the techniques discussed above.

The placement of coils, or other structures or materials, in theinternal space of an aneurysm or other defect has not been entirelysuccessful. The placement procedure may be arduous and lengthy,requiring the placement of multiple devices, such as coils, serially inthe internal space of the aneurysm. Longer procedures, in general,involve higher risks of complication from anesthesia, bleeding,infection, and the like. Moreover, because placement of structures inthe internal space of an aneurysm doesn't generally completely occludethe opening, recanalization of the original aneurysm is more likely tooccur, debris and occlusive material may escape from within the aneurysmand present a risk of stroke, vessel blockage or other undesirablecomplications. Blood may also flow into aneurysm and other blood vesselirregularities after the placement of embolic devices, which increasesthe risks of complication and further enlargement of the aneurysm.Furthermore, some aneurysms, vessels and other passageway defects arenot well-suited to placement of coils or other conventional occlusivedevices.

Devices for maintaining vaso-occlusive coils within an aneurysm havebeen proposed. One such device is described in U.S. Pat. No. 5,980,514,which discloses devices that are placed within the lumen of a feedvessel exterior to the aneurysm to retain coils within the aneurysmcavity. The device is held in place by means of radial pressure of thevessel wall. After the device is released and set in an appropriateplace, a microcatheter is inserted into the lumen behind the retainerdevice and the distal end of the catheter is inserted into the aneurysmcavity for placement of one or more vaso-occlusive devices. The retainerdevice prevents migration of occlusive devices from the cavity.

Another methodology for closing an aneurysm is described in U.S. Pat.No. 5,749,894, in which a vaso-occlusive device, such as a coil orbraid, has on its outer surface a polymeric composition that reforms orsolidifies in situ to provide a barrier. The polymer may be activated,e.g. by the application of light, to melt or otherwise to reform thepolymer exterior to the vaso-occlusive device. The vaso-occlusive devicethen sticks to itself at its various sites of contact and forms a rigidwhole mass within the aneurysm.

Devices for bridging the neck of an aneurysm have also been proposed.U.S. Patent Application 2003/0171739 A1, for example, discloses a neckbridge having one or more array elements attached to a junction regionand a cover attached to the junction region and/or the array elements.The array elements may comprise Nitonol alloy loops and the cover maycomprise a fabric, mesh or other sheeting structure.

U.S. Patent Application 2004/087998 A1 discloses a device and method fortreatment of a vascular defect in which two sheets, or a sheet and astrut structure function to secure the vaso-occlusive device and toocclude an opening. This patent publication lists numerous biocompatiblecompositions and materials that may be used in connection with thedevice to promote adhesion, fibrosis, tissue growth, endothelializationor cell growth.

U.S. Patent Application 2004/0193206 A1 discloses another device for atleast partially occluding an aneurysm including a plurality of elongatemembers configured to move relative to one another to transform thebridge between the delivery and deployed configurations. A two arraybridge, in which a first array is deployed inside the aneurysm and asecond array is deployed outside the aneurysm is also disclosed.

Septal defect closure devices are also well known. Such devices occludeopenings, or septal defects, in the heart or the vascular system. Septalclosure devices are disclosed, for example, in U.S. Pat. Nos. 6,077,291and 6,911,037. Bronchial flow control devices that seal or partiallyseal a bronchial lumen are also known, see, e.g., U.S. Pat. No.7,011,094.

Systems currently used for the detachment of implantable devices afterplacement include mechanical systems, electrolytic systems and hydraulicsystems. In mechanical systems, the occlusive device and the pusher wireare linked by means of a mechanical joint, or inter-locking linkage,which separates once the device exits the delivery catheter, therebyreleasing the device. Examples of such systems include those taught inU.S. Pat. Nos. 5,263,964, 5,304,195, 5,350,397, and 5,261,916.

In electrolytic systems, a constructed joint (generally either fiber- orglue-based) connects the pusher wire to the occlusive device. Once thedevice has been placed in the desired position, the joint iselectrolytically disintegrated by the application of a current or heat(for example, using a laser) by the physician. An example of such asystem is provided in U.S. Pat. No. 5,624,449. Such systems have thedisadvantage that dissolved material or gases generated by electrolysismay be released into the vasculature, thus presenting a potential hazardto the patient. Electrolytic detachment may also take more time toaccomplish than is desirable during an interventional operation in whichseveral occlusive devices are placed.

In hydraulic systems, the pushing wire is connected to the occlusivedevice by means of a polymer coupling. The pushing wire contains amicro-lumen to which the physician attaches a hydraulic syringe at theproximal end of the pusher wire. Upon the application of pressure on thesyringe plunger, the hydraulic pressure increases and forces the polymerjoint to swell and break, thereby releasing the device. An example of ahydraulic system is that described in U.S. Pat. No. 6,689,141.

Despite the numerous devices and systems available for occludingphysiological defects using minimally invasive techniques, theseprocedures remain risky and the results, even if successful in terms ofoccluding an opening, rarely restore the physiological structure to itsnormal, healthy condition. Methods and systems of the present inventionare directed, among other things, to reducing the length and complexityof minimally invasive procedures for occluding openings and repairing alumen or tissue defect, and to restoring a physiological structure, suchas a blood vessel, to its normal, healthy condition.

SUMMARY OF THE INVENTION

The present invention provides methods and systems for repairing anopening in an internal lumen or cavity within a subject's body usingminimally invasive techniques. In general, these systems and methods areused in connection with vascular abnormalities such as openings orcavities and are described herein with reference to their application toaneurysms and other types of blood vessel defects. It will beappreciated, however, that systems and methods of the present inventionare not limited to these applications and may be employed in a varietyof medical indications in which repair and reconstruction of an openingor cavity in a physiological lumen or passageway or tissue is desired.

In one aspect, methods and systems of the present invention providerepair and reconstruction of a lumen, such as a blood vessel, byplacement of a closure structure across an opening or cavity andretention of the closure structure across the opening using one or moreanchoring structures that serve as a means of endovascularly clippingthe opening or cavity, such as an aneurysm, and excluding it from theparent artery. Following placement, the closure structure substantiallycovers the opening or cavity and forms a generally continuous lumen wallthat is substantially similar to the conformation of the lumen wall inits healthy condition. Neither the anchoring nor the closure structuresinterferes substantially with the fluid flow in the lumen. Variousagents, such as agents that promote re-endothelialization and tissuegrowth, as well as bonding agents, therapeutic agents, anti-thrombolyticagents and the like may be provided to the repair site during orfollowing the placement procedure and/or in association with the system.

In another aspect, methods and systems of the present invention provideexclusion of a defect, such as an aneurysm, by placement of a closurestructure that restricts access to and cellular communication with thedefect across an opening or cavity and retention of the closurestructure across the opening using one or more anchoring structures.Methods and systems of the present invention may further promoteshrinking and reabsorption of the defect, or portions of the defect, andfacilitate hemostasis inside the defect. In one aspect, methods andsystems of the present invention for treatment of aneurysms not onlyrestore the structure and function of the parent vessel in the vicinityof the defect, but also stabilize material inside the aneurysm, preventdebris from escaping into the bloodstream, and promote a reduction inthe size and mass of the aneurysm.

Endoluminal and endovascular procedures are commonly used for placingimplantable devices and materials in many types of interventions. Anintravascular guide catheter is generally inserted into a patient'svasculature, such as through the femoral artery, and guided through thevasculature to, or approaching, a desired site of intervention.Additional delivery mechanisms and specialized catheters, such asmicrocatheters, pusher devices and the like, may be used to facilitatedelivery of various devices and accessories to the target site.Implantable devices are generally detachably mounted to a pusher ordelivery mechanism and navigated through the guide catheter to thetarget site, where they are deployed and detached from the deliverymechanism. The delivery mechanism is then withdrawn through the guidecatheter and additional devices, accessories, drugs or the like may bedelivered to the target site, if desired, prior to removal of the guidecatheter.

Methods of the present invention involve navigation of a deviceincorporating a closure structure and one or more anchoring structuresin a small diameter, delivery condition to a desired repair site usingminimally invasive, endoluminal techniques. In some embodiments, aguidewire is introduced and navigated through the guide catheter to thetarget repair site. The closure device may then be navigated to thetarget repair site and deployed over the guidewire. In a preferredembodiment, the closure device is preloaded in the distal portion of adelivery catheter sized for navigating physiological lumen(s) to thetarget repair site. The combination of the guidewire, the deliverycatheter, the closure device and a pusher or detachment device is sizedappropriately and has adequate flexibility and pushability to navigaterelatively long lumen distances and tortuous pathways, if necessary.Long and tortuous pathways must be traversed, for example, to deliverimplantable devices to the cerebrovasculature, and both the deliverycatheter(s) and the implantable devices must be sized and configured toprovide the required flexibility, pushability and guidance.

In one embodiment, methods of the present invention further involveguiding and positioning a defect closure system having a closurestructure and at least two sets of anchoring structures in proximity toa physiological defect or opening in a small diameter deliverycondition. In general, a first anchoring structure, or a first set ofanchoring structures, is positioned and deployed in contact with or inproximity to one surface near the physiological defect or opening. Upondeployment, the first anchoring structure(s) unfold and extend radiallyto assume the conformation of a generally circumferential structurelarger than the defect or opening and positioned generally around theperiphery of the closure structure. The closure structure is thenpositioned and deployed across the physiological defect or opening tosubstantially cover and occlude the defect or opening. Followingdeployment of the closure structure, a second anchoring structure, or asecond set of anchoring structures, is positioned and deployed incontact with or in proximity to another, generally opposed surface ofthe physiological defect or opening. The second anchoring structure orset of anchoring structures unfolds and extends radially to assume theconformation of a generally circumferential structure, larger than thedefect or opening and positioned generally around the periphery of theclosure structure on the opposite surface of the tissue (e.g., vesselwall) from the first anchoring structure(s). The anchoring structures ina deployed condition are preferably positioned in contact with orclosely adjacent opposite surfaces of the lumen or tissue near thedefect or opening, and the closure structure preferably substantiallycovers an opening and conforms to the structure and configuration of thelumen wall or the defect being closed to restore it to its normal,healthy structure and configuration. The anchoring structureseffectively serve as opposing clips, contacting opposed surfaces of thedefective structure, or extending to contact healthy tissue in proximityto the defect, to position and retain the closure structure in placeacross an opening.

Deployment of the defect closure system may be aided by placement ofradiopaque markers on the delivery catheter and/or the defect closuresystem. One or more radiopaque markers may be provided, for example, ata distal end of the device (when in a delivery condition), whichcorresponds to a first anchoring structure; at an intermediate portionof the device (when in a delivery condition), corresponding to theclosure structure; and/or at a proximal portion of the device (when in adelivery condition), corresponding to a second anchoring structure. Thedevice may then be deployed by positioning the distal radiopaque markeracross the defect opening and in the internal space of an opening orcavity in proximity to the opening and deploying a first anchoringstructure; positioning an intermediate radiopaque marker at the defectopening and deploying the closure structure; and finally positioning theproximal radiopaque marker slightly outside the opening and deployingthe second anchoring structure. The use and placement of radiopaquemarkers in connection with the closure device and/or delivery catheterfacilitates accurate positioning and deployment of the anchoring andclosure structures. The closure system is securely positioned andretained by positioning the anchoring structures on opposite faces ofthe lumen or tissue near the opening in a circumferential manner andpositioning the closure structure across the opening. The position ofthe closure system may be monitored following placement andpost-treatment by examining the position of the radiopaque markersprovided on the device with respect to the tissue defect or opening.

Implantable devices of the present invention employ a closure structureto substantially cover, occlude and extend over an opening or cavity intissue. The closure structure may be constructed from a variety ofdisparate materials, as described below, and may be provided with avariety of surface treatments and/or associated with a variety ofmaterials to provide properties desired for various applications. Thesize and configuration of the closure structure in the deployedcondition is preferably larger in at least one dimension than theopening of the defect, such as an aneurysm neck, so that the closurestructure substantially covers the opening when deployed. The closurestructure may have a substantially continuously occlusive surface areaor, in alternative embodiments, may have one or more openings tofacilitate placement using a co-axial guidewire and/or to facilitatedelivery of supplemental implantable devices or agents to the interiorof the cavity or defect following placement of the closure structure.

The closure structure, in some embodiments, is semi-permeable and hasgenerally radial flexibility sufficient to mimic the structure andmovement (e.g. pulsatility) of the vessel wall or other physiologicalstructure it's repairing. When the closure structure is placed acrossthe neck of an aneurysm, for example, it becomes substantiallycontinuous with and follows the motion of the vessel wall, providingeffective repair and reconstruction of the vessel wall and restoringstrength, structure and flexibility to the vessel wall. In a preferredembodiment, the closure structure and/or anchoring structures, afterplacement across a tissue or vessel defect, not only effectively repairthe defect, but promote cellular ingrowth and reendothelialization,thereby further incorporating the closure device in the physiologicalstructure and reducing the opportunity for the structure to weaken andreturn to a structurally or functionally defective condition.

The closure structure may incorporate a reinforcing structure throughoutits surface area, or in particular areas of its structure. In oneembodiment, for example, a resilient and flexible sheet material may bebonded to or associated with a more rigid reinforcing structure having aregular or irregular pattern. In one embodiment, a closure structure issupported in the area of its perimeter by a wire loop or frameworkstructure that provides structure and reinforcement and may,additionally or alternatively, incorporate one or more anchoringstructures. The reinforcement structure, in one embodiment, comprises acollar structure that is integral with one or more anchoring structures,or serves as a mounting structure for one or more anchoring structures.

In some embodiments, the anchoring structure(s) biases a closurestructure against the lumen wall and across an opening or defect from aposition inside or outside the lumen wall. In some embodiments, multipleanchoring structures are provided that bias a closure structure againstthe lumen wall and across an opening or defect from positions bothinside and outside the lumen wall. In yet other embodiments, multipleanchoring structures are provided, with at least one anchoring structurecontacting or in close proximity to an internal lumen wall in proximityto the opening or defect and at least one anchoring structure contactingor in close proximity to an external lumen wall or an internal wall of acavity or defect in the lumen. In one embodiment, anchoring structuresare positioned circumferentially both inside and outside a lumen defectin proximity to an opening or defect, and a closure structure ispositioned across the opening or defect, substantially covering theopening or defect, effectively excluding one side of the opening fromthe other and restoring the lumen to its original closed and continuousstructure.

In some embodiments, the anchoring structures are intended to at leastpartially contact one or both sides of a tissue or vessel wall inproximity to an opening or defect to position and support the closurestructure across the opening. The anchoring structures are generallyatraumatic and maintain the closure structure in position occluding thedefect without damaging the neighboring tissue or restricting blood flowin the vessel or tissue. In one embodiment, anchoring structures areprovided as loop or clip structures with openings and generally have amaterial density over their surface area that is less than the densityof the closure structure over its surface area. The implantable deviceis generally in a small diameter, generally cylindrical configuration ina delivery condition and, in this condition, the anchoring structuresgenerally project in opposite directions from the intermediate closurestructure. During deployment, the anchoring structures change shape andopen outwardly, in a circumferential fashion, to form a larger diametercircumferential anchoring structure. Distal and proximal anchoringstructures (as positioned in a delivery condition), which are deployedon opposite sides of a cavity or defect, may have substantially the sameconfiguration and dimensions, or the anchoring structures may bedesigned to have varying lengths, varying configurations, varyingstructures, and the like. In some embodiments, the anchoring structurespositioned inside and outside the lumen defect are substantially alignedwith one another, while in some embodiments, the anchoring structurespositioned inside and outside the lumen defect are substantiallystaggered or offset with respect to one another.

In another embodiment, the implantable device comprises a closurestructure, substantially as described above, in combination with one ormore anchoring structure(s) and/or collar or retaining structures. Inthis embodiment, an anchoring structure comprises at least twopositioning loops mounted on, or otherwise associated with, the closurestructure. The positioning loops, in a deployed condition, areconfigured and sized to contact interior walls of the aneurysm and/orblood vessel walls in proximity to the aneurysm, and to bias the closurestructure against the wall of the aneurysm or against blood vessel wallsin proximity to the neck of the aneurysm, thereby retaining the closurestructure in place substantially covering the neck of the aneurysm.

In a deployed condition, the closure structure and the anchoringstructure(s) may be positioned inside and/or outside the neck of theaneurysm. In one embodiment, for example, the implantable device isdeployed in the interior of an aneurysm such that opposed anchoringstructures contact the interior wall of the aneurysm and the closurestructure substantially covers the entrance or neck of the aneurysm,with the perimeter of the closure structure being in the interior of theaneurysm or contacting the vessel wall in proximity to the neck of theaneurysm. In another embodiment, the implantable device is deployed inthe blood vessel at the aneurysm such that anchoring structure(s)contacts the wall of the blood vessel, with the perimeter of the closurestructure substantially covering the neck of the aneurysm and contactingthe blood vessel wall in proximity to the neck of the aneurysm.Depending on the configuration of the anchoring structure(s), multipleanchoring loops may be positioned contacting or in close proximity tothe vessel wall near and/or generally opposite the neck of the aneurysmfollowing deployment.

In yet another embodiment, the implantable device comprises a closurestructure having a substantially tapered or truncated conical portionjoined to a closure membrane and an anchoring structure comprising atleast two positioning members. In this embodiment, the tapered portionof the closure structure preferably comprises a discontinuous meshstructure constructed from a shape change metallic material that, duringdeployment, expands to contact at least a portion of the internal wallof the aneurysm. The base of the tapered, discontinuous mesh structureis preferably joined to or associated with a closure membrane that, in adeployed condition, substantially covers the neck of the aneurysm.Anchoring structures are associated with the closure structure and maycomprise a plurality of positioning loops that, in a deployed condition,contact at least a portion of a vessel wall in proximity to the neck ofthe aneurysm. According to another embodiment, the anchoring structureshave at least two petal-like structures comprising, for example,metallic structures associated with permeable or impermeable coverings.According to yet another embodiment, the anchoring structure maycomprise a second tapered, discontinuous mesh structure having ashallower configuration than that of the closure structure.

The closure structure placed across the neck of the aneurysm may have acentral opening or slot for passage of a guidewire of another deliveryor targeting mechanism, or for introduction of compositions, devices, orthe like subsequent to placement of the closure system. According tosome methods of the present invention, additional embolic devices suchas coils, liquid or particulate embolics, or the like, may be introducedthrough a delivery catheter inserted through an opening of the closurestructure following placement of the closure structure. In someembodiments, the additional embolic substances and/or devices may act tobias the perimeter of the closure device against the interior wall ofthe aneurysm and thereby assist in retaining the closure structure inposition substantially covering the neck of the aneurysm.

Implantable devices disclosed herein may be delivered to the target sitethrough a delivery catheter using a pusher delivery system and/ordetachment mechanism. The closure structure, supporting framework andanchoring structures are generally radially compressed along thedelivery axis and arranged in a substantially cylindrical configurationin a delivery condition. In embodiments that utilize a pusher system,the pusher is located proximal to the proximal anchoring devices and cantranslate the closure device in relationship to the delivery catheter.Deployment may be achieved by a combination of actively pushing thedevice out of a delivery catheter and actively withdrawing the deliverycatheter while maintaining the device in a stationary condition. In analternative embodiment, implantable devices incorporate a detachmentelement that is released or detached following deployment. Detachmentmechanisms known in the art, including mechanical, electrolytic,hydraulic and other systems, may be utilized for deployment of theimplantable devices disclosed herein.

In one deployment system, a device wire is mounted on or associated withan implantable device of the present invention. A proximal end of thedevice wire is mountable on, or in proximity to, a detachment mechanismcomprising a shape change activation element having a generally linearconfiguration and being fixedly connected at its proximal end to adelivery wire, conduit, catheter or the like. The proximal end of thedevice wire and the distal end of the activation element have matingattachment mechanisms that, in a delivery condition, provide reliableattachment and guidance of the implantable device to the desireddetachment site. Detachment of the activation element from the devicewire following placement of the device at a desired location isaccomplished by applying a shape change force, such as heat or current,to the activation element, producing a shape change in the activationelement that releases the device wire, allowing withdrawal of theactivation element and delivery wire.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of applicants' claimed inventions are illustratedschematically in the accompanying drawings, which are intended forillustrative purposes only and are not drawn to scale.

FIG. 1A illustrates an enlarged schematic front perspective view of oneembodiment of an implantable closure device in a deployed condition.

FIG. 1B illustrates an enlarged schematic front perspective view ofanother embodiment of an implantable closure device in a deployedcondition.

FIGS. 1C, 1D, 1E and 1F schematically illustrate the closure devices ofFIGS. 1A and 1B deployed at the site of an aneurysm.

FIG. 2A illustrates an enlarged schematic front perspective view ofanother implantable closure device in a deployed condition and FIG. 2Bschematically illustrates the deployment of the implantable closuredevice of FIG. 2A at a vessel irregularity.

FIGS. 3A and 3B illustrate enlarged schematic front perspective views ofanother implantable closure device, with the device of FIG. 3A in apartially deployed condition and the device of FIG. 3B in a fullydeployed condition.

FIGS. 4A-4C schematically illustrate the implantable closure device ofFIGS. 3A and 3B in partially and fully deployed conditions. FIG. 4Ashows the implantable closure device being inserted into the neck of ananeurysm; FIG. 4B shows the device of FIG. 3B (in dashed lines) in adeployed condition inside an aneurysm and blood vessel; and FIG. 4Cshows the device of FIG. 3B in a deployed condition inside an aneurysmwith the aneurysm and blood vessel shown in cross-section.

FIG. 5 illustrates a closure structure comprising a flexible patchhaving a plurality of anchoring structures provided near a perimeter ofthe closure structure.

FIGS. 6A-6D illustrate enlarged, schematic perspective views ofimplantable devices having a neck element with stabilizing structures ina substantially deployed condition.

FIG. 7 illustrates an enlarged, schematic side view of anotherembodiment of an implantable device having a closure structure incombination with anchoring structures in a delivery condition.

FIG. 8 illustrates an enlarged, schematic side perspective view of animplantable device having opposed anchoring struts in a substantiallydeployed condition.

FIG. 9 illustrates an enlarged, schematic side perspective view ofanother embodiment of an implantable device having a generally bulbousocclusive member in a deployed condition.

FIG. 10 illustrates an enlarged, schematic side perspective view ofanother embodiment of an implantable device having a coil structure in adeployed condition.

FIG. 11 illustrates an enlarged, schematic side view of an implantabledevice of the present invention in a delivery system.

FIGS. 12A-E illustrate an enlarged, schematic view of a deploymentmethodology useful for placing devices of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Implantable systems of the present invention are described andillustrated, in detail, with respect to their application as aneurysmclosure devices. It will be appreciated, however, that these systems arenot limited to this application and may be adapted and utilized inconnection with the treatment and repair of other vessel, tissue or airpassageway cavities, abnormalities, or the like. Similarly, it will beappreciated that applicants' methods for repairing defects and openingsare not limited to the systems described herein.

Implantable closure devices of the present invention generally comprisea closure structure that is placed across a tissue or vessel defect andan anchoring structure that positions and holds the closure structure inplace. Many alternative embodiments and structures are disclosed herein.The flexible patch(es) or membrane(s) employed in the closure structuresdisclosed herein are generally constructed from a flexible material thatcan be delivered through a catheter in a small diameter deliverycondition and, in a deployed condition, assumes a larger dimensionconfiguration. In one embodiment, the closure structure is constructedfrom a material that is substantially impermeable to liquids such asblood and bodily fluids. Alternatively, the closure structure may beconstructed from a material that is semi-permeable or permeable toliquids, such as blood and bodily fluids, and allows at least limitedfluid exchange across the patch or membrane. The closure structure isimpermeable to particulates having a larger diameter than the pore sizeof a fluid permeable membrane comprising the closure structure. Theclosure structure may have numerous configurations, depending on thedevice application, and may be generally circular, elliptical, oval,triangular, polygonal or the like.

The closure structure is constructed from material(s) that isbiocompatible and biostable and that is compressible, foldable orotherwise deformable for assuming a low diametric profile in a deliverycondition for loading into or mounting to a delivery catheter. Materialsforming the closure structure may comprise, for example, many types ofnatural or synthetic polymeric materials, silicone materials, rubbermaterials, a woven or non-woven fabric material such as Dacron™, afluoropolymer composition such as a polytetrafluoroethylene (PTFE)material such as TEFLON,® or an expanded polytetrafluoroethylene (ePTFE)material such as GORE-TEX®, SOFTFORM®, IMPRA® or the like, a polymericmaterial such as polyurethane, polyurethane/silicone combinations andcopolymers, and the like. In another embodiment, a closure structure maycomprise a metallic material, such as a thin-film shape memory alloy,e.g., a thin-film Nickel-Titanium alloy such as a Nitinol alloy.Multiple membrane layers and membranes comprising multiple componentsand compositions may be provided. In some embodiments, the closurestructure is constructed from a material that is flexible and resilientand expands and contracts generally radially with the movement, orpulsatility, of the tissue or blood vessel in which it's placed.

In some embodiments, the closure structure comprises a mesh-likestructure having a uniform or non-uniform configuration over its surfacearea. In general, closure structures having a mesh configuration have agenerally fine mesh structure. In some embodiments, the closurestructure has a mesh-like structure that is radially expandable. Inother embodiments, the closure structure has a mesh-like structure thatis expandable along one or more axes.

The closure structure may have a porous or perforated surface structureover at least a portion of its surface area, with pores arranged toprovide a substantially uniform porosity over the surface area, or withpores arranged to provide different porosities at different surfaceareas of the closure structure. The average pore size may besubstantially uniform over the surface area of the closure structure, orpores having different size distributions may be provided. In general,pore sizes in the range of from about 0.5 microns to 200 microns aresuitable. In one embodiment, a pore structure is provided that permitsflow of liquids across the closure structure but excludes large proteinsand cells, including red blood cells. In general, pores having anaverage diameter of less than about 10 microns will exclude largeproteins and cells, while allowing fluids to penetrate and cross themembrane. The arrangement of pores may form a regular or irregularpattern and the conformation of the pores may be uniform or non-uniformand may be generally circular, elliptical, square, or the like. A higherporosity may be provided, for example, at peripheral portions of theclosure structure that, following placement, are in proximity to orcontacting the tissue or vessel wall.

The closure structure may, alternatively or additionally, have a surfacetreatment provided on one or both sides that promotes cellularattachment and growth. In one embodiment, for example, the materialforming the closure structure has a surface conformation that isirregular, or roughened, or incorporates surface irregularities thatpromote cellular attachment to the material. In another embodiment, theclosure structure may have a three dimensional configuration thatincorporates depressions, grooves, channels, or the like, in a regularor irregular pattern, to promote cellular attachment andre-endothelialization.

In some devices disclosed herein, the closure structure and/or othercomponents of the implantable device, including one or more anchoringstructures, are structured or treated to promote, or comprise a materialor substance(s) that promotes, cellular ingrowth or attachment at thesite of deployment. Similarly, methods of the present invention mayinvolve introduction of agent(s) that promote cellular ingrowth andre-endothelialization at the site of the device deployment prior to,during, and/or subsequently to placement of the implantable device. Forvascular applications, for example, it is desirable for someapplications to promote the re-endothelialization of the blood vessel atthe site of an aneurysm or another vessel defect that may be repaired byplacement of devices of the present invention. Numerous substances thatmay be used in connection with methods and systems of the presentinvention are described in U.S. Patent Publications 2004/087998 A12004/0193206 A1, which are incorporated herein by reference in theirentireties.

Numerous materials may be administered prior to, during or subsequent todevice deployment, or associated with the implantable device, to promotecellular ingrowth. Biocompatible materials may be used for this purposeincluding, for example, proteins such as collagen, fibrin, fibronectin,antibodies, cytokines, growth factors, enzymes, and the like;polysaccharides such as heparin, chondroitin; biologically originatedcrosslinked gelatins; hyaluronic acid; poly(.alpha.-hydroxy acids); RNA;DNA; other nucleic acids; polyesters and polyorthoesters such aspolyglycolides, polylactides and polylactide-co-glycolides; polylactonesincluding polycaprolactones; polydioxanones; polyamino acids such aspolylysine; polycyanoacrylates; poly(phosphazines); poly(phosphoesters);polyesteramides; polyacetals; polyketals; polycarbonates andpolyorthocarbonates including trimethylene carbonates; degradablepolyethylenes; polyalkylene oxalates; polyalkylene succinates; chitin;chitosan; oxidized cellulose; polyhydroxyalkanoates includingpolyhydroxybutyrates, polyhydroxyvalerates and copolymers thereof,polymers and copolymers of polyethylene oxide; acrylic terminatepolyethylene oxide; polyamides; polyethylenes; polyacrylonitriles;polyphosphazenes; polyanhydrides formed from dicarboxylic acid monomersincluding unsaturated polyanhydrides, poly(amide anhydrides),poly(amide-ester) anhydrides, aliphatic-aromatic homopolyanhydrides,aromatic polyanhydrides, poly(ester anhydrides), fatty acid basedpolyanhydrides, and the like; as well as other biocompatible ornaturally occurring polymeric materials, copolymers and terpolymersthereof, fragments of biologically active materials; and mixturesthereof.

Some biocompatible polymers are considered to be bioabsorbable and aresuitable for use in association with devices and methods of the presentinvention, including polylactides, polyglycolides,polylactide-co-glycolides, polyanhydrides, poly-p-dioxanones,trimethylene carbonates, polycaprolactones, polyhydroxyalkanoates, andthe like. Biocompatible polymers which are not generally considered tobe biodegradable may also be used, including polyacrylates;ethylene-vinyl acetates; cellulose and cellulose derivatives includingcellulose acetate butyrate and cellulose acetate propionate; acylsubstituted cellulose acetates and derivatives thereof, non-erodiblepolyolefins; polystyrenes; polyvinyl chlorides; polyvinyl fluorides;polyvinyl (imidazoles); chlorosulphonated polyolefins; polyethyleneoxides; polyethylene glycols; polyvinyl pyrrolidones; polyurethanes;polysiloxanes; copolymers and terpolymers thereof, and mixtures thereof.Exemplary polymers are well known in the art and one of ordinary skillin the art would understand that such polymers are by far too numerousto list here. Thus, this list is intended for illustrative purposes onlyand is not intended to be exhaustive.

Non-polymeric materials may also be used on connection with closuresystems of the present invention. Suitable non-polymeric materialsinclude, for example, hormones and antineoplastic agents. Examples ofother biocompatible materials which promote integration with thevasculature of the patient include, for example, processed human oranimal tissue including, for example, cells or cell fragments,engineered vascular tissue, matrix material from bladder, stomach,liver, genetic material of a natural or synthetic origin, and the like.

Other types of compositions may also be associated with a closurestructure or anchoring structure(s) forming the closure systems of thepresent invention. Hydrophilic and/or hydrophobic agents or bondingagents may be provided on all or a portion of the structure(s), forexample. Similarly, friction-reducing agents, including fluoropolymerssuch as PTFE, may be provided on all or a portion of the structure(s) tofacilitate deployment from a delivery catheter or sheath. Radiopaquemarkers or radiopaque compounds may be associated with certainstructures or portions of device structure to facilitate accuratepositioning, placement and monitoring of the deployed device. In oneembodiment, for example, a radiopaque composition may be incorporated inthe closure structure or provided as a coating on the closure structure.In yet another embodiment, certain therapeutic agents, antibioticagents, thrombogenic agents, anti-thrombogenic agents, and the like maybe associated with certain structures or portions of the devicestructure, or may be administered prior to, during or followingdeployment of the implantable device. Suitable agents are well known inthe art and are used in connection with other types of implantabledevices.

The closure structure may comprise multiple layers, and may have avariety of coatings or other materials associated with it, such asadherent or bonding substances, therapeutic substances, hydrophilic orhydrophobic materials, swellable materials such as hydrogels, radiopaquemarkers, and the like. In one embodiment, for example, a swellablehydrogel may be provided on a surface of the closure structure and/oranchoring structures that, in a deployed condition, face or contact aninternal portion of an aneurysm. In another embodiment, an agent orcombination of agents that promote embolization or thrombosis may beprovided on a surface of the closure structure and/or anchoringstructures that, in a deployed condition, face or contact an internalportion of an aneurysm to promote embolization inside the aneurysm. Inyet another embodiment, an agent or combination of agents that reducethrombosis and clotting, such as heparin, tissue plasminogen activator(tPA), Abciximab, and the like may be provided on a surface of theclosure structure and/or anchoring structures that, in a deployedcondition, face or contact a blood vessel or blood vessel wall. In stillanother embodiment, an agent or combination of agents that preventrestenosis and/or reduce inflammation to the site, such as Paclitaxel ora derivative or analog, Sirolimus, anti-inflammatory compositions suchas steroids, statins, ibuprofen or the like, may be provided on asurface of the closure structure and/or anchoring structures. In yetanother embodiment, a radioactive composition may be associated with asurface of the closure structure and/or anchoring structures fortherapeutic or imaging purposes.

The membrane forming the closure structure may have a substantiallycontinuous surface area or may be provided with one or more openings orslots that facilitate placement of the implantable device or mounting ofthe device on a catheter or delivery system in a delivery condition. Themembrane is secured to a framework or anchoring structure preferablycomprising a shape change material, such as a shape memory alloy, byforming, bonding, suturing, embedding, or the like. Some membranematerials may also be applied over or to a framework or anchoringstructure by coating, dip coating, and the like.

Framework components supporting the closure structure, such as anchoringstructures and reinforcing structures, may be constructed from abiocompatible shape change material that exhibits super-elastic behaviorand/or shape memory properties, such as shape memory alloys. The shapechange material changes shape in a predictable manner upon applicationof a shape change force such as heat, current or the like, to assume itspredetermined, deployed condition. The force for producing the shapechange is generally a change in temperature produced, for example, byintroducing the device into a body temperature environment, by applyingheat to the device using an external heating mechanism, or by heatingthe device by applying current through a conductive element. Uponheating of the shape memory material to, or above, a phase transitiontemperature of the material, the device framework structure and/oranchoring structure(s) assume their predetermined, larger dimensionconfiguration.

Nitonol alloy alloys exhibiting super-elastic behavior and shape memoryproperties are preferred shape memory alloys for use in devices of thepresent invention. Framework and anchoring structures may be formed, forexample, from solid wire, tubular wire, braided materials, or the like,and/or may be cut from a tube or cylindrical structure. Framework andanchoring structures may incorporate additional materials and may havecoatings or membranes provided between and among the frameworkstructures. In one embodiment, the framework and anchoring structuresmay be formed from a thin-film shape memory alloy, such as a thin-filmNitinol alloy, using sputtering techniques that are known in the art anddescribed below.

The implantable device is generally delivered to a target site using adelivery catheter or a specialized microcatheter (referred to as a“delivery catheter”) with a pusher catheter or rod, or using a pushersystem incorporating a detachment mechanism. In one system, for example,the closure structure is detachably mounted to the distal end of adelivery catheter in a low profile condition, and is covered andretained in the low profile condition by a retractable sheath. Thedelivery catheter may be positioned at or within the neck of an aneurysmusing conventional techniques and, upon retraction of the sheath, theclosure structure assumes its predetermined, deployed condition and isplaced across the neck of the aneurysm. More specifically, in a firststep upon retraction of a portion of the sheath, a first anchoringstructure is deployed and positioned contacting or in proximity totissue adjacent the aneurysm neck on the interior of the aneurysm; in asecond step, a closure structure or membrane is positioned across andsubstantially covering the aneurysm neck; and upon complete retractionof the sheath, a second anchoring structure is deployed and positionedcontacting or in proximity to the internal vessel wall adjacent theaneurysm neck.

FIG. 1A illustrates an embodiment of a closure device 30 comprising apatch or closure structure 31 mounted to or associated with twoanchoring structures 32, 33. Suitable materials for construction of theclosure structure or membrane are described above. Closure structure 31is supported by a framework structure 34 provided at least in aperimeter portion of and attached to closure structure 31 by means ofbonding, suturing, or the like. Framework structure 34 is mounted to orassociated with wing-like anchoring structures 32, 33. Both frameworkstructure 34 and anchoring structures 32, 33 preferably comprise a shapechange material such as a Nitinol alloy material.

Anchoring structures 32, 33 may comprise a solid wire or tubularstructure, or may be formed from a material having a braidedconstruction or another mesh-like structure. The configuration ofanchoring structures 32, 33 in a deployed condition is designed so thatat least a portion of anchoring structures 32, 33 contact an inner wallof an aneurysm or an internal wall of an associated blood vesselfollowing deployment. The configuration of anchoring structures 32, 33may be generally circular, oblong, or otherwise form a curvilinearconfiguration, or they may form a polygonal configuration. In apreferred embodiment, as illustrated in FIG. 1A, anchoring structures32, 33, are generally oblong curvilinear structures that curve outwardlyfrom attachment joint 35 to framework structure 34 and then backinwardly toward one another at the end remote from attachment joint 35.

In the embodiment illustrated in FIG. 1A, anchoring loops 32, 33 aregenerally the same configuration and are generally the same dimensionand are located generally opposite one another. In another embodiment,the anchoring structures may have different configurations and/ordimensions. In one embodiment, for example, one of the anchoringstructures may be longer and/or wider than the other anchoringstructure, or the anchoring structures may have differentthree-dimensional curvilinear or polygonal configurations. Although twoanchoring structures 32, 33 are illustrated, it will be appreciated thatadditional anchoring structures may be provided. Anchoring structuresare preferably arranged in a generally symmetrical fashion with respectto framework structure 34 and/or closure structure 31.

FIG. 1B illustrates a similar closure device comprising a closurestructure 36 having anchoring structures 37, 38 that attach to orproject from a framework structure 39 along opposed, lateral edges ofthe framework structure. Closure structure 36 may optionally have anopening or slot provided in a generally central region. Anchoringstructures 37, 38 as illustrated in FIG. 1B are gently curved and, attheir terminal sections, extend beyond corresponding terminal sectionsof the framework structure and the closure structure. The closure andframework structures in this embodiment are generally provided having asurface area that exceeds the surface area of the aneurysm neck, and theanchoring structures generally reside inside the aneurysm followingplacement of the device. In this configuration, the anchoring structuresexert lateral and downward force on the closure structure so that itgenerally conforms to the profile of the vessel wall at the site of theaneurysm, thereby sealing the neck of the aneurysm from flow in thevessel and providing reconstruction of the vessel wall at the site ofthe aneurysm.

FIGS. 1C-1F schematically illustrate the closure devices of FIGS. 1A and1B deployed at the site of an aneurysm. A bulge in blood vessel B formsan aneurysm A. As shown in FIGS. 1C and 1D, in one embodiment, whenclosure device 30 is deployed across the neck of and within aneurysm A,closure structure 31 is positioned to cover the opening of the aneurysmand anchoring structures 32 and 33 are retained inside and contact aninner aneurysm wall along at least a portion of their surface area. Inthis fashion, closure structure 31 and framework portion 34 aresupported across the aneurysm opening and biased against the neck of theaneurysm from outside the aneurysm. In the embodiment illustrated inFIGS. 1C and 1D, closure structure 31 and framework portion 34 aredeployed outside the internal space of the aneurysm. In an alternativeembodiment illustrated in FIG. 1E, closure structure 31 and frameworkportion 34 are supported across the aneurysm opening and biased againstthe neck of the aneurysm from inside the aneurysm.

FIG. 1F illustrates an alternative deployment system and methodology,wherein a closure device having at least two anchoring structures isdeployed such that closure structure 31 is positioned to cover theopening of the aneurysm and the anchoring structures 32, 33 arepositioned outside the aneurysm and contact an inner blood vessel wallin proximity to the aneurysm. In this embodiment, anchoring structures32, 33 may be generally sized and configured to match the inner diameterof the vessel in proximity to the neck of the aneurysm so that followingdeployment the anchoring structures contact the vessel wall in asubstantially continuous manner without straining or enlarging thevessel wall in the area of the aneurysm. In all of these embodiments,following placement of the closure device, the closure structuresubstantially covers the aneurysm neck to effectively repair the vesseldefect, and the anchoring structures do not substantially interfere withflow in the vessel.

FIG. 2A illustrates another closure device 40 comprising a closurestructure 41 supported by a framework structure 42 and mounted to orassociated with anchoring structures 43, 44, 45 and 46. The propertiesand configuration of closure structure 41 are generally as describedabove. Closure structure 41 is preferably supported by a frameworkstructure 42 provided at least in a perimeter portion of structure 41and attached to structure 41 by means of bonding, suturing, or the like.Framework structure 42 is mounted to or associated with two pairs ofwing-like anchoring structures 43, 44 and 45, 46. Framework structure 42and anchoring structures 43, 44, 45 and 46 preferably comprise a shapechange material such as a Nitinol alloy material and may comprise asolid wire or tubular structure, or may be formed from a material havinga braided construction or another mesh-like structure.

The configuration of anchoring structures 43, 44, 45 and 46, in adeployed condition, is designed so that at least a portion of each ofanchoring structures 43, 44, 45 and 46 contacts an inner wall of ananeurysm or an inner wall of an associated blood vessel followingdeployment. The configuration of anchoring structures 43, 44, 45 and 46,in a deployed condition, may be generally circular, oblong, or otherwiseform a curvilinear configuration, or they may form a polygonalconfiguration. In a preferred embodiment, as illustrated in FIG. 2A,anchoring structures 43, 44, 45 and 46 are generally oblong curvilinearstructures that curve outwardly from an attachment joint to frameworkstructure 42 and then back inwardly toward one another at the end remotefrom framework structure 42. In the embodiment illustrated in FIG. 2A,anchoring loops 43, 44, 45 and 46 form generally the same configurationand are generally the same dimension. Anchoring loops 43 and 46 arepositioned in a generally mirror image orientation with respect toanchoring loops 44 and 45, respectively. Similarly, 43 and 44 arepositioned in a generally mirror image orientation with respect toanchoring loops 46 and 45, respectively. In alternative embodiments, theconfiguration and/or dimension of each of anchoring loops 43, 44, 45 and46 may vary and the configuration and/or dimension of each of anchoringloops 43, 44, 45 and 46 may be different. Although two pairs ofgenerally opposed anchoring structures are illustrated, it will beappreciated that additional anchoring structures or pairs of opposedanchoring structures may be provided. Anchoring structures arepreferably arranged in a generally symmetrical fashion with respect toframework structure 42 and/or closure structure 41.

FIG. 2B illustrates a closure device of the type shown in FIG. 2Adeployed such that patch 41 is positioned to cover the opening of theaneurysm, with two of the anchoring structures positioned inside theaneurysm, contacting at least a portion of the aneurysm wall, and two ofthe anchoring structures positioned outside the aneurysm, contacting aninner blood vessel wall in proximity to the aneurysm. Methods forrepairing a vessel using a closure device of the type shown in FIG. 2Agenerally involve deploying a first anchoring structure comprising, forexample, anchoring loops 43, 46 inside the neck of aneurysm A, andpositioning anchoring loops 43, 46 in proximity to or contacting theinternal aneurysm wall near the aneurysm neck; deploying the closurestructure 41 across the neck of the aneurysm to substantially cover theaneurysm neck; and deploying a second anchoring structure comprising,for example, anchoring loops 44, 45, outside the aneurysm neck andpositioning anchoring loops 44, 45 in proximity to or contacting theinternal blood vessel wall near the aneurysm neck.

Alternative embodiments of aneurysm closure devices are illustrated in apartially deployed condition in FIG. 3A and a fully deployed conditionin FIG. 3B. In this embodiment, closure device 50 comprises a taperedclosure structure 51 having a generally truncated conical configurationjoined to a closure membrane 52 having the properties of the closurestructure described above, and having an anchoring structure comprisingmultiple positioning members 53, 54, 55 and 56.

Tapered closure structure 51 preferably comprises a porous or mesh-likestructure constructed from a shape change metallic material that, in adelivery condition, provides a low profile, small diameter structure andexpands during deployment to an enlarged, deployed condition in which itcontacts a least a portion of the internal wall of the aneurysm. Theporous or mesh-like structure may have generally large or small spacesbetween the structures and the spaces and structures may be symmetricalor asymmetrical and may be generally curved or generally linear andangular. Suitable types of expanding mesh-like structures are known andused, for example, in various types of stents. Tapered closure structure51 may be covered or associated, at least in part, with a flexiblefabric or membrane material that is biocompatible and biostable such asa silicone material, a PFTE material, Dacron™, or the like, or may beassociated with other types of fibrous materials.

Tapered closure structure 51 may be joined to or associated with closuremembrane 52 at a smaller diameter base portion 57. Closure structure 51may have a perimeter that corresponds generally to the configuration ofsmaller diameter base portion 57 or, alternatively, the perimeter ofclosure structure 51 may have a larger or differently shapedconfiguration from that of smaller diameter base portion 57. In oneembodiment, for example, closure structure 51 is mounted on orassociated with a framework structure 58 in proximity to its perimeterand is mounted to or associated with base portion 57 at a locationinternal to its perimeter.

Positioning members 53, 54, 55 and 56 of closure device 50 may have aloop-like structure similar to the anchoring structures described above.Alternatively, positioning members 53, 54, 55 and 56 may comprise asolid metallic structure, a mesh-like discontinuous structure, or astructure in which a flexible material is mounted on or associated withframework structures defining the positioning members. Two or morepositioning members may be provided and are arranged in a generallyradially symmetrical arrangement with respect to closure structure 51.In another embodiment, a tapered, discontinuous mesh structure having ashallower configuration than that of tapered closure structure 51 may beprovided as an anchoring structure.

FIGS. 4A-4C illustrate the closure device 50 during deployment and in adeployed condition following deployment in and across an aneurysm. FIG.4A illustrates closure device 50 partially inserted into an aneurysm A.Tapered closure structure 51 is deployed as a first anchoring structurethrough the aneurysm neck and positioned within the aneurysm withmembrane 52 extending across and substantially closing the neck of theaneurysm. The positioning members 53, 54, 55 and 56 are deployed andreside outside the aneurysm neck following deployment and contact atleast a portion of the blood vessel wall in proximity to the neck of theaneurysm. Placement of this closure system thus repairs the vessel walland restores the vessel to a substantially normal and healthyconfiguration.

FIG. 5 illustrates another embodiment of an implantable device 60comprising a flexible closure structure 61 having a plurality ofanchoring members 62 mounted on, or retained near, the periphery of theclosure structure. Anchor members 62, as shown, have at least twospaced-apart arms 63, 64 and may be mounted at an interior or exteriorsurface of closure structure 61 or may alternatively be mounted throughthe closure structure, with opposing arms 63, 64 extending from oppositesurfaces of closure structure 61. Arms 63, 64 may be located on closurestructure such that a peripheral rim 65 of structure 61 is arrangedoutside the junction of opposing arms 63, 64 with closure structure 61.

Implantable device 60 is preferably radially foldable or compressiblefor minimally invasive delivery through catheter devices. In thedelivery condition, arms 63, 64 may be in a substantially linearcondition so that the device may be delivered in a small diameter,substantially cylindrical configuration. Following delivery of thedevice to the desired target site in a small diameter, deliverycondition, one series of arms is deployed to its larger deploymentcondition and positioned on the interior of the aneurysm wall inproximity to the aneurysm neck. The other series of arms is deployedsubsequently, causing both series of arms to assume theirthree-dimensional, spaced apart and generally opposed positions, withthe second series of arms positioned on the internal blood vessel wallin proximity to the aneurysm neck. Closure structure 61 is positionedacross the aneurysm neck to substantially cover the opening duringdeployment of the respective anchoring arms. Following placement ofimplantable device 60 across the neck of an aneurysm, closure structure61 substantially covers the neck and arms 63, 64 provide anchoringpoints both inside the aneurysm and in the blood vessel. Peripheral rim65, having a larger diameter cross section than that of closurestructure 61, may provide additional coverage of the aneurysm neckand/or the vessel wall in proximity to the aneurysm neck.

FIGS. 6A-6D illustrate alternative closure devices. Closure system 70,shown in FIG. 6A, comprises a central closure structure 71 with areinforced neck structure 72 and a plurality of anchoring structures 73and 74. Closure structure 71 may optionally have an opening or slotprovided in a generally central region. Reinforced neck structure 72 maybe integral with closure structure 71 or constructed separately andmounted in proximity to a perimeter of closure structure 71. Neckstructure 72 comprises a reinforcement member 75 and a flexible membranemember. In combination, the reinforced neck structure forms anupstanding collar structure that may be generally cylindrical, oval orthe like, and is intended, following placement at the neck of ananeurysm, to project into the interior of the aneurysm and seal the neckregion from the vessel. The reinforcement member 75 may be provided in azig-zag pattern, as shown, or in another pattern in which it providesstructural support for the upstanding neck structure. Althoughreinforced neck structure 72 is illustrated as projecting in a directionsubstantially orthogonal to the plane of closure structure 71, it willbe appreciated that reinforced neck structure 72 may project in adirection that forms either an acute angle or an obtuse angle withrespect to the plane of closure structure 71, depending on the desiredapplication and the conformation of the body structure desired to beoccluded.

Closure system 70 additionally comprises a skirt portion 76 extendingfrom closure structure 71 or neck structure 72 and having a largerperimeter than either closure structure 71 or neck structure 72. Theskirt portion acts to further seal boundaries of the opening desired tobe occluded and is intended to remain on the outside of theopening—contacting, in the example of an aneurysm, the blood vessel wallin proximity to the neck of the aneurysm. Using a device incorporating askirt portion is particularly desirable in applications where thegeometry of the opening is irregular, and the dimensions of the skirtportion may be adjusted accordingly. The skirt portion preferablyincreases the deployed diameter of the occlusive device by at leastabout 10%, more preferably at least about 15% and, in some embodiments,at least about 20%. In yet other embodiments, the skirt portionpreferably increases the deployed diameter of the occlusive device by atleast about 30%.

Anchoring structures 73, 74 are preferably constructed from a generallyrigid material, preferably a shape memory material such as Nitinol. Inthe embodiment illustrated in FIG. 6A, anchoring structures 73 and 74project on opposite sides of the plane of closure structure 71 and arejoined by an intermediate structural support 77. The anchoringstructures may be integral and provided as a single structure, orseparate and oppositely positioned anchoring structures may be provided.Anchoring structures 73, 74 are illustrated in FIG. 6A as having agenerally triangular configuration with rounded corners. In analternative embodiment of closure device 78 shown in FIG. 6B, theanchoring structures have a more rounded, paperclip-like structure.

Anchoring structures may assume a variety of sizes and configurationsand may have a generally broad or narrow profile. The anchoringstructures may be substantially similar in size and configuration asillustrated or anchoring structures having different sizes andconfigurations may be provided. For some applications, anchoringstructures may have a mesh-like or porous configuration. Although threesets of anchoring structures are illustrated, it will be appreciatedthat fewer or more anchoring structures may be provided and that theanchoring structures are generally arranged in a radially symmetricalarrangement with respect to the central patch.

FIG. 6C illustrates a similar closure system 80 comprising a centralclosure structure 81 having a generally cylindrical collar region 82 andflared skirt portion 83. The interface between collar region 82 andflared skirt portion 83 is generally curved and continuous.Reinforcement is provided by opposing anchoring arms 84, 85 which arestaggered with respect to each other and arranged in a generallyradially symmetrical pattern.

FIG. 6D illustrates a portion of another closure device 130 of thepresent invention in a partially deployed condition. Closure device 130comprises first and second sets of anchoring structures 132 and 134projecting from opposite sides of an intermediate collar structure 136and generally transverse closure structure 138. Anchoring structures 132and 134 are preferably constructed from a shape change material thatforms a substantially cylindrical structure in the delivery conditionand changes conformation during deployment to provide a larger diameterstructure having anchoring structures 132, 134 forming a substantiallycircumferential, ring-like structure in the deployed or partiallydeployed condition, as shown in FIG. 6D. Anchoring structures 132, 134may be substantially as illustrated in FIG. 6D in a deployed condition,or they may curve further toward a centerline of the device in a fullydeployed condition, depending on the type and structure of the tissuedefect being repaired by the implantable device. Similarly, intermediatecollar structure 136 may have a substantially upstanding, cylindricalconfiguration in a fully deployed condition, as illustrated in FIG. 6D,or the intermediate collar structure may be angled or curvedcircumferentially outwardly, in combination with the anchoringstructures, to provide a structure that contacts and firmly clamps thedevice to the tissue in proximity to the defect in an atraumatic manner.Various curved and/or bent device configurations in the deployedcondition may be provided, depending on the size of the defect, the typeand thickness of tissue being repaired, and the like.

Anchoring structures 132 and 134 are preferably substantially atraumaticand constructed to minimize trauma to tissue they contact in a deployedcondition. In one embodiment, anchoring structures 132 and 134 have agenerally cylindrical or tubular structure and cross-sectionalconfiguration. In the partially deployed configuration illustrated inFIG. 6D, anchoring structures 132, 134 project on opposite sides ofintermediate collar structure 136 and are arranged in a substantiallyaligned configuration, whereby upon deployment at a target site,opposing anchoring structures contact opposite tissue surfaces inproximity to a defect in substantially the same location. The distalterminal ends of anchoring structures 132, 134 form a generally largesurface area, terminating in a generally blunt structure, to provide asubstantially non-traumatic anchoring structure that contacts tissue topositively position and retain the closure structure across a defectwithout damaging the tissue it contacts.

While anchoring structures 132 and 134 are illustrated as generallytriangular, wire structures having an overall length greater than thelength of the intermediate collar structure, it will be appreciated thatalternative configurations may be used. The anchoring structures mayincorporate additional reinforcing or pressure distribution structuresthat may take the form of additional structures or surface areas.Alternatively or additionally, membranes such as those used forconstructing the closure structure may be provided in connection withone or more anchoring structures.

One or more radiopaque markers are preferably provided in proximity tothe ends of anchoring structures 132, 134 remote from intermediatecollar structure, which correspond to the distal and proximal ends ofthe implantable device in a delivery condition. Radiopaque markers maybe provided, for example, by associating a radiopaque material with aportion of the anchoring structure. Suitable radiopaque materials suchas tantalum, gold, silver, barium, platinum, tungsten, and the like maybe used. Radiopaque markers may be associated with an anchoringstructure, for example, by gluing, adhering, crimping, welding, laserwelding, or the like. Bands 133 and 135 may, for example, incorporate orcomprise or be associated with radiopaque markers, thus marking theterminal ends of both sets of anchoring structures during and followingdeployment.

Intermediate collar structure 136 comprises reinforcing structure formedfrom ribs 137 that form a generally cylindrical reinforcing structureand are provided in a generally denser structure than that of anchoringstructures 132, 134. Ribs 137 form a generally criss-crossing structureand may be bonded to, or associated with a membrane structure that isflexible and may be substantially coextensive with the collar structure.The collar structure may form a generally upstanding cylindricalstructure in a deployed condition or, as described above, the collarstructure and ribs may be angled or curved in an outward circumferentialconformation. Transverse closure structure 138 may be mounted on orbonded to or formed with intermediate collar structure 136 and/or amembrane structure associated with the collar structure and may besubstantially continuous or may be provided with a slot or opening forpassage of a guidewire or another instrument. One or more radiopaquemarker(s) is preferably associated with collar structure 136 and/ortransverse closure structure 138.

FIG. 7 illustrates yet another embodiment of a closure device 120 of thepresent invention in a small diameter, delivery condition. Closuredevice 120 illustrated in FIG. 7, comprises first and second sets ofanchoring structures 122 and 124 projecting from opposite sides of anintermediate collar structure 126 and generally transverse closurestructure (not shown). Anchoring structures 122 and 124 preferablycomprise a shape change material and form a substantially cylindricalstructure in the delivery condition as shown in FIG. 7. These anchoringstructures (122, 124) bend radially outwardly during deployment to forma substantially circumferential, ring-like structure in the deployedcondition.

Anchoring structures 122 and 124 are preferably substantially atraumaticand constructed to minimize trauma to tissue they contact in a deployedcondition. In one embodiment, anchoring structures 122 and 124 have agenerally flattened structure and cross-sectional configuration. In theembodiment illustrated in FIG. 7, anchoring structures (122, 124) havesubstantially the same configuration, project on opposite sides of theintermediate collar structure, and are arranged in a substantiallystaggered or offset configuration. One of the anchoring structures,124A, is longer than its neighboring structures. In alternativeembodiments, anchoring structures 122 and 124 may vary in configurationand/or size, and may be arranged in a radically symmetrical orasymmetrical configuration. In the deployed condition, anchoringstructures 122, 124 contact generally non-overlapping portions of tissueon opposite sides of the defect being closed. This arrangement isgenerally non-traumatic and promotes and preserves tissue viability andblood flow in areas contacted by the closure device. Enlarged distal andproximal pads, 123 and 125, respectively, may be associated with one ormore anchoring structures 122 and 124, respectively, to promotepositioning and deployment of the closure device and to provide a largerdiameter contact footprint in areas of tissue contact.

While anchoring structures 122 and 124 are illustrated as generallytriangular, flattened wire structures having an overall length greaterthan the length of the intermediate collar structure, it will beappreciated that alternative configurations may be used. The anchoringstructures may incorporate additional reinforcing or pressuredistribution structures that may take the form of additional structuresor surface areas. Alternatively or additionally, membranes or meshstructures such as those used for constructing the closure structure maybe provided in connection with one or more anchoring structures.

One or more radiopaque markers are preferably provided in proximity tothe ends of anchoring structures 122, 124 remote from intermediatecollar structure, which correspond to the distal and proximal ends ofthe implantable device in a delivery condition. Pads 123 and 125 may,for example, incorporate or comprise or be associated with radiopaquemarkers, thus marking the terminal ends of both sets of anchoringstructures during and following deployment. Suitable radiopaquematerials such as tantalum, gold, silver, barium, platinum, tungsten,and the like may be used. Discrete radiopaque markers may be associatedwith the anchoring structures, for example, by gluing, adhering,crimping, welding, laser welding, and the like.

Intermediate collar structure 126 comprises a generally cylindricalreinforcing structure formed from ribs 127 that form a generallycylindrical reinforcing structure and are provided in a generally denserstructure than that of anchoring structures 122, 124. Ribs 127 arebonded to, or associated with a membrane structure (not shown) that isflexible and, in this embodiment, is substantially coextensive with thecollar structure. The membrane structure may be associated with orformed integrally with a transverse closure structure (not shown).Radiopaque markers may additionally or alternatively be associated withcollar structure 126 and/or the transverse closure structure.

FIG. 8 illustrates yet another embodiment of a closure device 90 inwhich an enlarged closure structure 91 provides an occluding surface inits central region and also provides the substrate for attachment of areinforcing structure comprising a plurality of anchoring struts 92 and93 that, in a deployed condition, form a petal-like loop pattern withopposed struts 92 and 93 being in a substantially mirror-imageconfiguration. Struts 92, 93 are joined to one another by means ofintermediate structures 94. The reinforcing structure may be formed as asingle, interconnected structure or multiple independent structures maybe connected, or mounted coordinately with one another.

As closure device 90 is deployed following delivery of the device, in asmall diameter delivery condition to the neck of an opening, anchoringstruts 92 are deployed first to the interior of the opening andpositioned contacting or in proximity to the internal wall of theaneurysm, with intermediate structures 94 positioned generally at theneck of the opening. As deployment progresses, anchoring struts 93 aredeployed and contact the internal vessel wall in proximity to theaneurysm opening, and the closure structure 91 is drawn against theopening from the direction of the vessel. In this embodiment, closuredevice 91 may be used to occlude openings having irregularconformations.

FIG. 9 illustrates yet another embodiment of a closure device 100 in anexpanded, deployed condition. Closure device 100 comprises a generallycurved conical or bulbous structure 101, which may be formed, forexample, from thin-film shape memory alloy, such as Nitinol. Curvedstructure 101 terminates at a small diameter end in a closure structure(not shown) and has an opening at the larger diameter end. In theembodiment illustrated in FIG. 8, curved structure 101 comprises amembrane wall 102 or a plurality of membrane panels reinforced by aplurality of ribs 103. Ribs 103 are generally arranged in a radiallysymmetrical pattern and fewer or more ribs may be provided. In anotherembodiment, membrane wall 102 may be reinforced by a mesh-like structureor another type of framework structure.

Closure device 100 additionally comprises at least one retainingstructure 104 for positioning, and retaining device 100 across anopening. Retaining structure 104 may be in the form of a curved orcoiled strip, or may be formed as a petal-like or loop-like structure,and multiple retaining structures 104 may be provided. During deploymentof device 100, bulbous structure 101 is positioned for expansion insidethe opening, while retaining structure(s) 104 remain outside the neck ofthe opening and anchor the device 100 within the opening by contactingthe wall of the structure in proximity to the opening.

FIG. 10 illustrates yet another embodiment of a closure device 110having a spiral configuration. A framework structure may be provided,for example, by reinforcing structures 112 and 114 provided at theinternal and external boundaries of the spiral structure and a membrane116 may be mounted to or formed integrally with the framework structure.In one embodiment, the spiral structure has a smaller diameter end and alarger diameter end. In another embodiment, a closure device of thepresent invention may comprise an opposed, dual spiral coilconfiguration. In this embodiment, an opposing coil structure comprisingtwo coils joined in the middle at their small diameter portions andexpanding radially in opposite directions (in an ascending/descendingpattern) are provided.

A coil reinforcement structure may comprise Nitinol wire or a similarbiocompatible, preferably shape change material, embedded or mounted toa membrane material that forms the closure structure. The membrane hasdimensions such that overlapping loops of the membrane affixed to thecoil reinforcement structure, when in a coiled configuration, formoverlapping boundaries. Closure device 110 is deployed such that theterminal and larger diameter end of one of the coils is positionedinside the opening to be occluded and, as the device is deployed, thespiral shape forms and tightens against the opening. The small diameterportion of the device where the two opposing coil structures meet ispositioned across the neck of the opening and the opposite coil isdeployed into the region outside the opening and contacts the wall ofthe structure (such as a blood vessel) in proximity to the opening.

As outlined above, closure structures and membranes employed in theclosure systems disclosed herein can be formed of a thin-film shapememory alloy, such as a thin-film Nitinol alloy. The thin-film Nitinolalloys employed in membranes and closure structures of the presentinvention preferably has a thickness of from about 0.5-100 microns, morepreferably of from about 2-50 microns, and may be composed of between45-55% each of titanium and nickel.

Thin-film Nitinol alloys may be prepared, for example, using sputteringtechniques as described in U.S. Pat. No. 6,533,905, the disclosure ofwhich is hereby incorporated by reference in its entirety. Suchtechniques may employ a mandrel, formed of steel, glass, silicon or thelike, that has an exposed, etchable outer layer onto which issputter-deposited a thin layer of a Nitinol alloy. Following sputterdeposition, the thin layer of Nitinol alloy formed on the mandrel isheated under annealing conditions and the resulting thin-film isreleased from the mandrel, for example by exposing the mandrel andattached thin-layer to an etchant. Fenestrations, or small openings orpores, may be formed in the thin-film Nitinol alloy by forming a resistlayer containing a pattern of openings on the annealed thin-film,exposing the coated thin-film to a solvent in order to createfenestrations corresponding to the pattern of openings, and removing theresist layer. Structural members may be positioned on the mandrel priorto sputter deposition of the Nitinol alloy, so that the thin-film isattached directly to the structural member.

The framework, or support members, and anchoring members employed in theclosure devices may be cut or etched, for example, from a tube orcylinder of a thin-film shape memory alloy, such as a thin-filmtitanium-nickel alloys (e.g., Nitinol alloys). Techniques for etchingthin-film shape memory alloys are well known in the art. In oneembodiment, a thin-walled tube can be prepared, for example, asdescribed by Gupta et al. (SMST-2003: Proc. Intl. Conf. Shape MemorySuperelastic Technol., (Pacific Grove, Calif.) eds. A. R. Pelton & T.Duerig, p. 639, 2003). Briefly, multiple layers of think film Nitinolalloys and a sacrificial material (such as chromium) are sputterdeposited sequentially onto a flat substrate surface, such as a polishedand oxidized silicon wafer, with the first deposited layer being formedof chromium, and two subsequently deposited layers of Nitonol alloybeing separated by a second layer of chromium. The Nitonol alloy layersmay be from 1 to 40 microns in thickness, while the chromium layers maybe approximately 500 Angstroms in thickness. Two photomask plates(referred to as Mask 1 and Mask 2) are employed, the masks havingpre-determined pattern designs which determine the size and shape of theresulting structure, in this case a cylinder or tube. Mask 1 containsthe design used to pattern the second chromium layer on the wafer andmask 2 contains a design to pattern the Nitonol alloy layers. StandardMEMS techniques are used to pattern the thin-film Nitonol alloy andchromium layers. Following deposition of the thin-film Nitonol alloy andchromium layers on the wafer, the multi-layered thin-film structure isremoved from the wafer by immersing it in chromium etchant to dissolveall the chromium layers, creating a pocket between the first and secondNitonol alloy layers. The released thin-film structure, which has agenerally rectangular shape, is transformed into a three-dimensionalcylinder by inserting a close-fit mandrel formed, for example, fromstainless steel, into the pocket between the two Nitonol alloy layersand heat treating the structure at 500° C. in a vacuum. Fenestration ofany desired size, shape and pattern can be formed in the Nitonol alloylayer using standard photolithography techniques.

In another aspect, the implantable systems disclosed herein comprise aclosure device having a device wire that, in combination with adetachment joint, detachably connects the implantable device to adelivery/pusher wire. A device wire is generally integral with orattached at its distal end to the implantable device through thedetachment joint and employed to deliver the implantable device to thedesired location in the body, generally by navigation through a guidecatheter. Suitable device wires, detachment joints and delivery/pusherwires are well known in the art and may be used in association withclosure devices of the present invention. Materials that may be employedfor the device and delivery wires are well known in the art.

Closure systems of the present invention are used to repair defects inblood vessels such as aneurysms, and other physiological defects orcavities formed in lumens, tissue, and the like. Methods and systems ofthe present invention provide repair and reconstruction of a lumen wallor tissue defect using minimally invasive endoluminal techniques andwithout requiring invasive surgical procedures. The delivery anddeployment procedures are generally straightforward and less timeconsuming than many alternative procedures and consequently reduce therisk of complications.

FIG. 11 illustrates an implantable device of the present inventionloaded in a delivery catheter for navigation to and deployment at atarget repair site, and FIGS. 12A-E illustrate an exemplary delivery anddeployment methodology. Delivery system 140 comprises a deliverycatheter 142 having suitable dimensions, flexibility and pushability fornavigation to a desired target repair site, such as an aneurysm orcavity formed in blood vessel. For embodiments in which delivery to thetarget delivery site, such as a neurovascular aneurysm, involvesnavigation through small lumen(s) and/or tortuous pathways, deliverycatheter 142 may comprise a microcatheter having a small diameter and agenerally high flexibility. Distal segment(s) of the delivery cathetermay be more flexible, for example, than proximal sections. Numerousdelivery catheters are known in the art and are suitable for use indelivery systems of the present invention.

Repair device 144, which may be any of the repair and/or occlusiondevices described herein having two sets of opposed anchoringstructures, is preferably preloaded in a small diameter, deliverycondition, in a distal end 141 of delivery catheter 142. A distal end145 of repair device 144, as it is positioned for delivery in deliverycatheter 142, preferably corresponds to an anchoring structure intendedfor placement at the internal wall of an aneurysm or cavity to berepaired, or at a lumen wall or cavity surface that is opposite theinternal wall relative to the delivery pathway. One or more radiopaquemarkers 146 may be provided at or near distal end 145 of repair device144. Proximal end 147 of repair device 144, as it is positioned fordelivery in delivery catheter 142, preferably corresponds to ananchoring structure intended for placement at a vessel wall near theneck of an aneurysm or cavity to be repaired, or at an inner lumen wallor cavity surface relative to the delivery pathway. One or moreradiopaque markers 148 may be provided at or near proximal end 147 ofrepair device 144. Repair device 144 may additionally or alternativelyincorporate a radiopaque marker in proximity to a central portion of thedevice, corresponding generally to a closure structure 149 of thedevice. Radiopaque markers may additionally or alternatively be providedin association with delivery catheter 142, marking locationscorresponding to the distal and proximal portions of repair device 144,respectively.

The delivery system illustrated in FIGS. 11 and 12A-E employs aguidewire 150 for guidance and positioning of repair device 144 and apusher 152 having a guidewire lumen and positioned for contacting aproximal portion 147 of repair device 144 and moving it in relation todelivery catheter 142. Suitable guidewires and pushers are well known inthe art and may be used for delivery of repair and occlusion devices ofthe present invention.

Methods for repairing a physiological defect or closing an opening orcavity 160 thus involve navigating a repair device 144 in a smalldiameter, delivery condition to a target repair site over a guidewire150 using non-invasive or minimally invasive techniques and positioninga distal end of the repair device 144, corresponding to a firstanchoring structure 145, at or in the opening to be repaired, asillustrated in FIG. 12A. Alternatively, repair device 144 may bepositioned by positioning a radiopaque marker associated with anintermediate collar or closure structure 149 across the opening of theaneurysm or defect 160 in blood vessel 170. The first anchoringstructure, which generally comprises a series of anchoring arms 145, isthen deployed by pushing the distal end of the repair device 144 out ofthe delivery catheter 142 and/or withdrawing the delivery catheter 142to position the first set of anchoring structures in proximity to orcontacting the internal aneurysm wall in proximity to the neck, as shownin FIG. 12B. Upon deployment, the first set of anchoring arms 145expands and unfolds circumferentially, with the anchoring structurespositioned contacting or in proximity to a surface of the defectopposite, or on the other side of, the defect being repaired from theperspective of the delivery pathway. Radiopaque markers 146 provided onthe first anchoring structure may be monitored, during deployment andpositioning, to assure correct and atraumatic positioning.

Following deployment of the first anchoring structure, an intermediateportion of the repair device comprising the closure structure 149 isdeployed generally across the opening to be repaired and occludes thedefect opening, as shown in FIG. 12C. Upon deployment of theintermediate closure structure 149, the closure structure unfolds orexpands to substantially cover the opening. In this condition, the firstset of anchoring arms 145 contacts or is in close proximity to one sideof the internal wall of the aneurysm in proximity to the opening and theclosure structure 149 covers the cavity opening. The proximal section ofthe repair device, comprising a second anchoring structure 147 andassociated radiopaque markers 148 is then deployed, as shown in FIG.12D, by pushing out of the delivery catheter 142 or withdrawing thecatheter in relationship to the closure device. Upon deployment of thesecond anchoring structure, its anchoring arms 147 expand and unfoldoutwardly and are positioned contacting or in proximity to a surface ofthe defect bordering or forming part of the delivery pathway. At thispoint, the closure device 144 is securely deployed and the guidewire 150is withdrawn into the delivery catheter 142. The delivery system 140 iswithdrawn from the site and the closure device effectively repairs theopening, as shown in FIG. 12E.

Methods and systems of the present invention thus effectively repair ananatomical defect or opening by mounting a closure structure tosubstantially cover the opening and supporting and retaining the closurestructure in position across the opening with anchoring structurespositioned on both opposed surfaces of the lumen or tissue in proximityto the defect. Subsequent regrowth of cells and re-endothelialization oftissue in the area of the device placement effectively restores tissuefunction and effectively repairs the defect. Radiopaque markers arepreferably used to deploy and position the device and may be used tomonitor the position of the device at various times following placement.

While in the foregoing specification this invention has been describedin relation to certain preferred embodiments thereof, and many detailshave been set forth for purposes of illustration, it will be apparent tothose skilled in the art that the invention is susceptible to variouschanges and modifications as well as additional embodiments, and thatcertain of the details described herein may be varied considerablywithout departing from the basic spirit and scope of the invention.

All of the patent references and publications cited in thisspecification are incorporated by reference herein in their entireties.

1. An implantable device for repairing an opening or cavity in a targettissue defect, the implantable device being adjustable from a deliverycondition in which it assumes a generally small diameter configurationto a deployed condition in which it assumes a larger diameterconfiguration, the implantable device comprising: a closure structuresized to substantially cover the opening or cavity when the device is inthe deployed condition; and a first anchoring structure extending in afirst direction from the closure structure and a second anchoringstructure extending in a generally opposite second direction from theclosure structure when the device is in the delivery condition, thefirst and second anchoring structures forming generally circumferentialstructures having a diameter larger than that of the closure structurewhen the device is in the deployed condition.
 2. An implantable deviceof claim 1, additionally comprising at least one radiopaque markerassociated with at least one of the first and second anchoringstructures.
 3. An implantable device of claim 2, comprising at least oneradiopaque marker associated with each of the first and second anchoringstructures.
 4. An implantable device of claim 1, additionally comprisinga radiopaque marker positioned intermediate the first and secondanchoring structures.
 5. An implantable device of claim 1, additionallycomprising a radiopaque marker associated with the closure structure. 6.An implantable device of claim 2, wherein the radiopaque markercomprises a composition selected from the group consisting of: tantalum,gold, silver, barium, platinum, tungsten and combinations thereof.
 7. Animplantable device of claim 1, wherein the closure structure has asubstantially continuous occlusive surface area.
 8. An implantabledevice of claim 1, wherein the closure structure has at least oneopening to facilitate passage of another device.
 9. An implantabledevice of claim 1, wherein the closure structure has radial flexibilitysufficient to mimic the structure and movement of the target tissue. 10.An implantable device of claim 1, wherein the closure structurecomprises a material selected from the group consisting of: siliconematerials; rubber materials; woven and non-woven fabrics; fluoropolymercompositions; polymeric materials, polyurethane materials, metallicmaterials and combinations thereof.
 11. An implantable device of claim1, wherein the closure structure comprises a thin film shape memoryalloy.
 12. An implantable device of claim 1, wherein the closurestructure has a porous surface structure provided over at least aportion of its surface area.
 13. An implantable device of claim 1,wherein the closure structure comprises a material that is permeable toliquids but substantially excludes cells from traversing the closurestructure.
 14. An implantable device of claim 1, additionally comprisinga reinforcing structure having framework structure in proximity to theperimeter of the closure structure.
 15. An implantable device of claim1, additionally comprising a collar structure provided in proximity to aperimeter of the closure structure, the collar structure forming agenerally cylindrical structure and extending in a plane generallyorthogonal to that of the closure structure in a delivery condition. 16.An implantable device of claim 1, wherein the anchoring structures aregenerally atraumatic and have a material density over their surface areathat is less than the density of the closure structure over its surfacearea.
 17. An implantable device of claim 1, wherein the anchoringstructures comprise a biocompatible shape memory alloy material.
 18. Animplantable device of claim 1, wherein the first and second anchoringstructures have substantially the same configurations and/or dimensions.19. An implantable device of claim 1, wherein the first and secondanchoring structures have different configurations and/or dimensions.20. An implantable device of claim 1, wherein the first and secondanchoring structures are substantially aligned with one another in adeployed condition.
 21. An implantable device of claim 1, wherein thefirst and second anchoring structures are substantially staggered withrespect to one another in a deployed condition.
 22. An implantabledevice of claim 1, wherein the first and/or second anchoring structureshave a mesh-like or porous configuration.
 23. An implantable device ofclaim 1, incorporating a material selected from the group consisting of:agents that promote cellular ingrowth and attachment at the target site;hydrophilic agents; hydrophobic agents; bonding agents;friction-reducing agents; radiopaque agents; antibiotic agents;thrombogenic agents; anti-thrombogenic agents; therapeutic agents;hydrogel compositions; anti-inflammatory agents; anti-restenosis agents;radioactive agents; and combinations thereof.
 24. A delivery systemincorporating an implantable device for repairing an opening or cavityin a target tissue defect, comprising: a delivery catheter having adistal end for delivery to a site in proximity to a target tissuedefect; an implantable device assuming a substantially cylindricalconfiguration in a delivery condition and comprising a closure structuresized to substantially cover the opening or cavity and a first andsecond set of anchoring structures extending in substantially oppositedirections from the closure structure, the implantable device beingpositioned in a lumen in the distal end of the delivery catheter.
 25. Adelivery system of claim 24, additionally comprising a pusher positionedproximally to the implantable device.
 26. A delivery system of claim 24,additionally comprising a detachment mechanism having a device wire anda detachable element associated with a proximal portion of theimplantable device in the delivery condition.
 27. A method for repairingan opening or cavity in a target tissue defect, comprising: (a) guidinga repair device comprising a first anchoring portion, a second anchoringportion, and a closure structure located intermediate the first andsecond anchoring portions to the site of the target tissue defect usingminimally invasive techniques; (b) deploying the first anchoring portioninside the opening at the site of the target tissue defect and therebypositioning the first anchoring portion circumferentially in proximityto or in contact with a first tissue surface surrounding the opening;(c) deploying the closure structure across the opening to substantiallycover the opening; and (d) deploying the second anchoring portionoutside the opening at the site of the target tissue defect and therebypositioning the second anchoring portion circumferentially in proximityto or in contact with a second tissue surface surrounding the opening,the second tissue surface generally opposite the first tissue surface.28. The method of claim 27, additionally comprising navigating aguidewire to a site in proximity to the target tissue defect and guidingthe repair device to the site of the defect over the guidewire.
 29. Amethod of claim 27, additionally comprising introducing an agent to thesite of the target tissue defect selected from the group consisting of:agents that promote cellular ingrowth and attachment at the target site;bonding agents; radiopaque agents; antibiotic agents; thrombogenicagents; anti-thrombogenic agents; therapeutic agents; hydrogelcompositions; anti-inflammatory agents; anti-restenosis agents;radioactive agents; and combinations thereof.
 30. A method for occludingan aneurysm in a body lumen, comprising: (a) navigating an occludingdevice comprising a closure structure located intermediate first andsecond anchoring portions in a small diameter, delivery condition to asite in proximity to a neck of the aneurysm using minimally invasivetechniques; (b) deploying a distal region of the first anchoring portionthrough the neck of the aneurysm in the interior of the aneurysm,thereby positioning a first circumferential anchoring structure having adiameter larger than that of the opening in proximity to an internalaneurysm tissue surface surrounding the neck of the aneurysm; (c)deploying the intermediate closure structure across the neck of theaneurysm, thereby substantially covering and occluding the opening; and(d) deploying the second anchoring portion outside the neck of theaneurysm, thereby positioning a second circumferential anchoringstructure having a diameter larger than that of the neck of the aneurysmin proximity to a surface of a blood vessel wall in proximity to theneck of the aneurysm.
 31. A method for excluding an aneurysm from aparent vessel and promoting a reduction in the mass of the aneurysmcomprising: positioning a closure structure across an opening of theaneurysm that substantially covers the opening and restricts cellularcommunication between the aneurysm and the parent vessel; and retainingthe closure structure in position using at least one anchoring structurepositioned inside and/or outside the opening of the aneurysm.